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PCM2 E2 COPY > Neuro Cases 1 > Flashcards

Neuro Cases 1 Flashcards

1
Q

What is the most frequent headache type in population studies?

what about the most common diagnosis in patients presenting to clinicians?

A

tension HA

migraine

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2
Q

What are the 4 types of primary HA?

A

tension-type

Migraine

Cluster

Other

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3
Q

Where are migraines located? (adults vs children)

tension type?

cluster? where does it begin?

A

unilateral in most adults, bilateral in most kids

bilateral

always UNILATERAL, begins around the eye or temple.

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4
Q

Migraine Characteristics?

Tension HA characteristics?

Cluster HA characteristics?

A

Gradual in onset –> crescendo and pulsating

pressure or tightness which waxes and wanes

pain begins quickly reaching crescendo within minutes, deep, and continuous, excruciating

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5
Q

Duration of Migraines? tension HAs? Cluster HAs?

A

4-72 hours

30 minutes to 7 days

15 minutes to 3 hours

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6
Q

What are associated symptoms with migraines? tension HAs? cluster HAs?

A

nausea, vomiting, photophobia, phonophobia

NONE

ipsilateral lacrimation and redness of the eye, stuffy nose, pallor, etc

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7
Q

Migraine patient appearance? Tension HA? Cluster?

A

prefers to be in a dark, quiet room

may be active or may want to rest

REMAINS ACTIVE

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8
Q

Danger signs of a headache?

A

SNOOP

systemic symptoms

neuro symptoms or abnormal signs

Onset is new (particularly for age over 50 years and sudden –> thunderclap

Other associated conditions –> head trauma, worse with valsalva, worse with sex

Previous HA history with HA progression or change

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9
Q

Need for emergency is what signs?

A

thunderclap

acute or subacute neck pain or HA with Horner syndrome

meningitis/encephalitis

papilledema

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10
Q

Morbidly obese.. tearful, holding hand to left side of head

TTP noted at left occipital condyle

Paraspinal neck musculature tight, ropy, TTP. cranial vault has severely diminished CRI

A

Occipital neuralgia

Tension headache (if unilateral)

headache secondary to obstructive sleep apnea

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11
Q

Occipital Neuralgia is what?

what causes it?

what confirms it?

what is the tx?

A

unilateral, starting at the area where the neck meets the skull and moving forward to involve the ear and forehead

caused by trauma to the nerves, including pinching by tight neck muscles, compression of the nerve, or tumors.

greater occipital nerve block

massage, NSAIDS, muscle relaxants

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12
Q

Central causes of vertigo? (3)

peripheral (4)

other? (3)

A

Vestibular migraine, cerebrovascular disease, meningioma of the cerebellopontine angle

BPPV, vestibular neuritis, meunière, otosclerosis

med induced, psychiatric, CV/metabolic

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13
Q

Dizziness that increases with motion is common in what cause?

A

both central and peripheral

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14
Q

Vertigo is considered what?

A

sensation of self-motion when they are not moving or a distorted self-motion during normal head movement

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15
Q

What causes vertigo?

A

result of asymmetry within the vestibular system

disorder of peripheral labyrinth of its central connection

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16
Q

How do we evaluate dizziness? mnemonic?

A

TiTrATE

Timing of the symptom

Triggers that provoke the sympom

And a Targeted Examination

17
Q

If someone has brief episodes of intermittent dizziness that last from seconds to hours, what is it most likely? (episodic)

A

Benign Paroxysmal Positional Vertigo

18
Q

What are common triggers of episodic dizziness?

A

head motion or change in body position

19
Q

Spontaneous episodic symptoms for dizziness means what?

unilateral hearing loss?

sx of migraine HA?

what if the symptoms are episodic and BECOME continuous.. what should you consider?

A

no triggers, so other elements of the history help determine the Dx

consider meniere

consider vestibular migraine

psychiatric diagnosis

20
Q

Continuous vestibular symptoms? how does this differ with episodic?

classic symptoms? (5)

what is it mostly related to? (2 things)

23% of older adults with dizziness. what is it usually related to?

A

usually last days to week… episodic dizziness lasts hours to days

dizziness or vertigo w/ N/V, nystagmus, gait instability, head motion intolerance

trauma or toxin

their medications

21
Q

how many meds is associated with increased risk of dizziness?

A

5

22
Q

if someone has continuous vestibular symptoms but has no history of toxin or trauma, what should you consider?

A

vestibular neuritis or central etiologies

23
Q

Targeted exam.. what test do you do?

what is it confirming the dx of?

A

Dix-Hallpike –> turn patients head to right or left 45 degrees, then the person lays down with their head off the table while you hold the head like that. same with the other side.

you’re looking for return of signals of nystagmus

then its confirmatory for BPPV

24
Q

BPPV

1) what’s causing it?
2) what age is it most likely hitting people at?
3) treatment in office?
4) home treatment?
5) meds?

A

loose canaliths get stuck in semicircular canals

most common at ages 50-70, if earlier consider head trauma

Epley Maneuvers in office

Brandt-Daroff exercises

no need for meds

25
Q

Vestibular Neuritis

1) what is this ranking on vertigo
2) what causes it?
3) ages?
4) 4 major symptoms?
5) what is NOT useful in this case?

A

2nd most common cause

virus

30-50, male or female

rotatory vertigo with movements of objects moving in the periphery of their vision… falling to affected side, horizontal nystagmus to non-affected side.

Dix-Hallpike because symptoms aren’t positional

26
Q

Meniere disease?

1) what is it?
2) what ages?
3) how severe is the vertigo in this case?

A

vertigo + hearing loss +/- tinnitus

any age, 20-60 most likely

extremely severe, often needs bedrest

27
Q

Vestibular Migraine?

1) what causes it?
2) what about if it’s in kids?
3) who’s more likely to have it, man or woman?
4) classic treatment?

A

Episodic vertigo in patient with Hx of migraine

most common form of vertigo in kids

women, 3x more likely

stress relief, adequate sleep/exercise, etc.

28
Q

left nystagmus on EOM testing

failed whisper test on R

Romberg +

dix-hallpike +

A

Meniere disease

PCM2 E2 COPY (11 decks)

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